Accountable Care Organizations: What They Are and How Psychiatrists Can Thrive In The Accountable Care Era North Carolina Council of Community Programs.

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Presentation on theme: "Accountable Care Organizations: What They Are and How Psychiatrists Can Thrive In The Accountable Care Era North Carolina Council of Community Programs."— Presentation transcript:

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INTRODUCTION Part One: Elements for a successful ACO and implementation steps which transcend provider resource or facility and apply equally to all ACO stakeholders. Part Two: Recommended ACO strategies for psychiatrists. 2

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Part One: The Keys to ACO Success 3

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WHAT IS AN ACO? A provider-based organization; That takes responsibility for healthcare needs of a defined population; With goals of improving health, improving efficiency, and improving patient satisfaction; That should include primary care physicians; And produces shared savings or other financial measures to align incentives. 4

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HOW IS THIS DIFFERENT FROM A MEDICAL HOME? The Patient-Centered Medical Home (“Medical Home”) empowers primary care to coordinate care for patients across the continuum of care. It can become the core of an ACO but lacks the financial incentives, like shared savings, to encourage providers to deliver the highest quality at the lowest cost. It does not involve specialists. 5

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ESSENTIAL ELEMENT 3: ADEQUATE ADMINISTRATIVE CAPABILITIES (cont’d.) Who should be in an ACO? – All primary care? – What about specialists? – What about hospitals? – What about community partners? How many in a region? 17

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ESSENTIAL ELEMENT 5: HEALTH INFORMATION EXCHANGE CAPABILITY AND DATA (cont’d.) Basic EHR ACO IT Infrastructure HIE Scope of Information Sharing Functional Complexity Patient health information available at point of care Reporting capabilities to state and federal agencies Patient health information available at point of care Data mining capabilities to contribute to financial impact modeling, value reporting, and payor negotiations Decision support capabilities at point of care Expanded access to patient records across the continuum Comparative data collection to determine gaps in care delivery processes and outcomes vs. peers Reporting capabilities to state and federal agencies Patient health information available at point of care 20

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ESSENTIAL ELEMENT 7: PATIENT ENGAGEMENT What can an ACO do to engage patients? Why is it so important? 22

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ESSENTIAL ELEMENT 8: SCALE-SUFFICIENT PATIENT POPULATION Economies of scale; savings pool How a start-up ACO can get there 23

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THE 8 ESSENTIAL ELEMENTS OF A SUCCESSFUL ACO 24

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Part Two: Applying the ACO Strategies to Psychiatrists 25

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WHY CARE? – PRO Return of control of physician/patient relationship Leverage your power to heal With > one-half primary care physician visits associated with psycho/social issues, averaging 2x to 3x the costs, psychiatrists well positioned for pay-for- performance Essential to be in “narrow network” because of aggressive payor steerage to them America rapidly moving away from fee-for-service to value-based payment 26

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WHY CARE? – CON No time, no war chest, no experience Some ACOs don’t include psychiatry Hard to be interdependent with others This too shall pass Being unprepared is an option 27

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PSYCHIATRY’S POTENTIAL TO ADD VALUE (AND RECEIVE CORRESPONDING REWARD) Psychiatric disease as a co-morbidity “is the rule rather than the exception” in high-cost cases. ( Robert Woods Johnson) The ACO approach accepts the premise that treatment for general physical care must be integrated with mental health and substance abuse treatment. Impact Model shows benefit. 29

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WE’VE GOT SOME GREAT VALUE-ADD CONTRIBUTIONS—NOW WHAT? Pick the right ACO(s) Have them want to pick you o Relationships o Have a compelling story o Primary care is the client o Protect your legal and financial interests 32

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METRICS ARE KEY You must own the metrics. They should reflect each selected initiative’s tasks (process) you want to occur and goals (outcomes) you want to achieve. Do not waste your contributions: even if you do a great job, if the metrics are off, you will not be rewarded. 33